Implementación de los Grupos relacionados de diagnóstico en una institución de salud de alta complejidad en Colombia

ABSTRACT

Background: One of the greatest challenges for health care institutions is to know the hospital product (HP), defined as patients, diagnoses and resources used in health care. Proper measurement of HP allows an effective resource management. The Diagnosis Related Groups (DRG) system facilitates the measurement of HP, classifying patients according to their characteristics, complexity, and resource consumption. Aim: To describe the implementation of DRGs in a high complexity health care institution in Colombia and to describe the incidence of coding errors. Material and Methods: A random sample of 98 episodes was selected out of 3802 episodes registered from June to September 2019. We described the cumulative incidence of errors in the assignment of main diagnoses, procedures and the variable "Present on admission" (POA). Results: An incorrect assignment of the main diagnosis was found in 18/98 episodes (18%, 95% confidence intervals (CI)11-27). Seventeen of 98(17%-95% CI10.4-26) and 8/98(8%-95% CI 3.6-15) had incorrect assignment of POA ("NO" or "YES" respectively). Eighteen episodes had at least one procedure incorrectly assigned (19% − 95%CI (11.4 − 28.5)). Conclusions: The use of DRGs improves hospital efficiency. Its implementation is possible in health care institutions in Colombia. However, the commitment of the institution's clinical and administrative staff is essential.